Book Reviews

The idea of a native mode of considering and evaluating Indian cultural products has often surfaced prominently in the country's intellectual discourse. Recurrent versions of this enterprise are as inevitable as, say, incessant American projects for defining the American-ness of its culture. And this is so for good reasons: these are both major nations and they make justifiable metropolitan claims. Such, one presumes, is also the case in China and Russia. As Gayatri Chakravorty Spivak, although no loud advocate of national assertions, has rightly pointed out, postnationalism is "Northern radical chic"(A Critique of Postcolonial Reason [Harvard, 1999], 375). Nativism: Essays in Criticism, edited by Makarand Paranjape, brings together just over two dozen articles which were initially presented, in earlier versions, at the first of two major high-level symposia in India devoted to sordng out the dimensions and features of a native Indian critical perspective and idiom. This particular gathering was convened by Sahitya Akademi — the National Academy of Letters — and the second one, more recently, by the Indian Institute of Advanced Studies. I understand that the projected volume from that later meeting is currently in press. Together, these two volumes ought to provide an overview of the complex and (to date) dialogic exploration of this important terrain. For obvious enough reasons, "nativism" is a difficult term to explain to Western readers; it might very easily be taken to suggest a divide between the native born and the newcomer. Such a reading, however, is not likely to make much sense in the Indian context, given that racially different immigrants do not exist in that country in any significant or even statistically reportable numbers, nor is immigration any part of recent or current national policy or large-scale practice. (The case would be quite different, I imagine, in Malaysia, Singapore, or Sri Lanka.) And while Indian ethnicities may vary within what is after all a diverse subcontinent, the main issues are

1 ( death to the brain in an indirett way. A ligature of the carotids dij not fuduenlv kill, 011 account of the anaftomofis with the arteria vertebra is. The author endeavours to explain why animals, into whcie lyltem of veflels air is brought, fuddenly die, from the cerebral motion being deftroyed b. the contadl of the air, whence the function of the heart and the circulation are flopped. Young horfes, whofe blood-vcfTeb were filled with air, tumbled do .n in convulfions, and expired a few minutes after.
Ai!T. 3. In bat manner does ike death of the heart produce the death of the lwgs ? In the funftion of the lung?, two pnenomena are oblerved; the fir ft of which is purely mechanical, and confifts in the elevation and depreflion, in the dilatation and contraction of the thorax, &c by the mufcles and diaphragm, and in the entry and exit of the air; the eccnd is, chemical. When the heart cea es to adl with the veinous blood, the chemical proc.fs of the lungs is deftroyed; but when the heart die? firlt with the arterhl blood, the mechanical motions ceafe; becaufe the death of the brain, which only afts upon voluntary mufcles, occafions the ceflation of the adlion of the parts belonging to the motive powers of the thorax.
Art. 4 hi tvhai manner docs the death of the heart produce the death of all the organs ? Jn animal life, 1. Becaufe every organ is no mo,e ftimulated by blood ; and, 2. Eecaufe the brain, by wanting "JSelf the neceflary ftimulus, is unable to communicate it to the organs fubordinaie to it. In the organic life, 1. Becaufe the neceffary excitation is ceucient. 2. Becaufe the materials requilite for the continuation of this life are wanting. The author makes here fome ingenious remarks on the excitation of the organs by the motion of the entering blood, and particularly on the different motions of the brain, which confift in an "alternate elevatio and collapfus, that are caufed by the entrance of the blood, &c.
Art. 5. In what manner does the death of the lungs produce the death of the heart ? The fuppreflion of the mechanical motions of the lung? is occafioned by different caufes. The author, however, agrees with Goodwyn. that the folds of the larger and capillary veiTels-in and near the air-cells, do not <bftrudt the circulation of the blood, when expiration is for a long time continued ; and he thinks likewife, that an extenfion of the air-cells, by a long con-? nued inspiration, does not difturb the circulus fanguinis minor.
The ceflatioii of the mechanical motions flops the circulation, by d^ft oying the chemical procefs. Mr, Goodwyn, however, is of opinion, that the cauh. of afphyxia may be derived from the black Oi Veinous blood not fuffixiently ftirnulating the left ventricle. From a want of air lit for refpiration the procefs of oxygenifation cannot proceed, and the body dies; becaufe the left heart being paralyfed, pulhes forward neither black nor red blood. This Opinion, however, appears inefficient to our author, on which account he propofes another, which likewife labours under fome difficulties. Though he admits, in fome ineafure, the paralytic effedl of the black blood, yet he thinks that it ftill continues for fome time iiine to ftimulate the red blood veffeis almoft as much as the red blood itfelf; but as foon as it penetrates the inner texture of the heart, and the reft of the organs, it deftroys the life of every mufcular and nervous fibre ; but whdher this is done by a fuperabundance of carbon or hydrogen, is not yet explained. Art. 6. In what manner does the death of the lungs produce the death of the brain ? The black blood, by penetrating the texture of the brain, deftroys its aftion. On tranfufing red blood into the temporal artery, the animal remained lively and well; whereas the injeftion uf veinous bl od killed it in a moment, and injedled ink, gall, urine, ferum fanguinis, had the fame effeft. When thefe fluids were inie&ed into the arteria cruralis, they occafioned a ftupefac^ tion and paralyfis, but never death. The blood from the arteria carotis of a dog, affiled with afphyxia, when injefted into the carotid of another dog, had a mortal effect. Art. 7. In what manner does the death of the lungs produce the death of all organs? The author treats here of the procefs of refpiration and coloratio fanguinis, which is performed in the extremities of the bronchia:. The art of changing black bloo 1 into red, proceeds always in proportion to the quantity of air fit for refpiration, that is contained in the lungs. An animal, breathing hydrogen and carbonic gas, becomes reftlefs after three minutes, and 5 minutes after the blood of the carotids becomes black. The black blood penetrates the mufcles, nerves, fkin, &c. hence the blue and livid appearance of the neck, cheeks, face, &c. in drowned people, or thofe that are fuffocated by the fmoke of coals. The blood of the'arteria umbilicalis in a pregnant bitch, lying in afphyxia, was quite as black as that of the vena umbilicalis. There exifts no difference of colour in the blood of the foetus of the Guiney pig. The chemical procefs in the lungs ceafes always fooner than circulation ; and it is on 'his account that in dead bodies we always find black, and never red blood. A r t . 8. In 'what manner does the death of the lungs produce the general death? The fucceffion of the phenomena of general death, occafioned by the death of the lungs, is related here. The afphyxia: do not merely depend on the penetration of the black blood into the texture of the lungs, brain, &c. but, 1. They arife from a want of air fit for refpiration. 2. They come on when, befides this, a deleterious fluid enters the lungs, as mephitic air. &c. which particularly feem> to affett mortally the nerves of the lungs by entering into tne blood, and even the brain itfelf. Art. 9. In what manner does the death of the brain produce the death of the lungs? The author aiTerts, that the brain has ho diredt influence on the lungs, and death is imparted from the brain to the lungs through the medium of the diaphragm and the intercoftal mufcles.
Art. 10. In what manner does the denth of the brain produce the death of the heart ? The brain has likewife no immediate influence on the heart; but this dies after the function of the lu'igs being 4eftroyed, whence the death of the heart arifes. The author avails himfelf himfelf of the Galvanic experiments, in order to explain this difficult part of his fyftem, in which attempt he difplays much ingenuity and acutenefs. Art. 11 ? In iviat manner does the death of the brain produce the death of all organs? The brain has no immediate influence 011 the funftions of the organic life; but the death of the brain can only effeft the death of the reft of the animal organs by producing the death of different intermediate organs.
Ideas on the ganglia and the ner-vus Jympatheticus magnus. All organs, that receive their nerves from ganglia, are not fubordinate to the adlion of the brain and to the will. The fympatnedc nerve confifts in a re-union of fmall nervous fyftems, each of which has a ganglion as the central point, independent of one another; they anoftomofe with the medulla fpinalis, and with each other. The nerves that arife from thefe fmall fyftems, are not to be confidered as dependent on the great fyftem of nerves which belong to animal life.
Art. 12. In ivhat manner does the death of the brain produce the general death ? As the death of the brain is not capable of direilly deftroying the fundlions of the inner life, the following fuccofiion in the celfation of the general life takes place. 1. Seniibility and locomotion ceafe. 2. Diaphragm and the intercoftal mufcles become paralytic. 3. The mechanifm of refpiration is deftroyed. 4. The chemical procefs of the lungs ceafes. 5. B ack blood enters into the fyftem of red blood. 6. Circulation is obftrudled. 7. The heart dies, and the circulation entirely ceafes. 8. The organic life, and, 9. The animal heat, are extinguilhed. And, at laft, 10. The white organs, as they are called, die, becaufe their nourifhing fluids are almoit entirely independent of the great circulation. After having ftated the theory of Dr. Wichmann on difficult dentition, by which he attempts to overthrow entirely the exiflence of it, as a morbid phenomenon, we think it incumbent upon us to propofe and difcufs what might and has been faid againft this opinion, fo diametrically oppofite to common obfervation and experience. On this account we doubt not, but that by far the greateft part of our readers will have been furprifed at the paradoxical affertions of Dr. Wichmann, and recapitulated in their minds the different contrary arguments, that either their own experience, or the obfervations and authority of medical writers, may fuggeft to them.
Tt can be eafily conceived, that in Germany alio many antagonists have arofe againfl the above theory, equally powerful in their arguments and authority as pra&itioners-However, though we are fully convinced, that many points in the opinion of Dr. Wichmann, cannot be well admitted, as being contrary to impartial obfervation, yet we ought not to deny, that this great practitioner has occafioned by his ideas, medical men to fubmit fuch an important fubje.l to new examination, and to throw more light upon it; by drawing from experience pra?tical refults; in fhort, to fix more accurately the limits of the caufes of infantile difeafes than hitherto has been done.
It is certain, that hydrocephalus, fcrophula, acor primarum viarum, &c. have been frequently overlooked ; and the fymptoms attending thefe morbid affedlions, falfely afcribed to a difficult denr tition, particularly as they in a great meafure occur at the period of teething. However, on the other fide, by adopting the ideas of Dr. Wichmann, pradtitioners are unavoidably led to derive all morbid affeftions of the infantile age from an acor in the ftomach, hydrocephalus, fcrophula, &c. and by difregarding entirely dentition, to incur the danger of not employing that mode of practice, which is properly indicated.
On the perufal of Dr. Wichmann's opinion, the chief point which he has premifed to his other arguments is, undqubtedly, that the Dr. JVichmant?s Theory of difficult Dentition. the gums, or thofe parts, which by the irritation of a tooth breaking through, may excite pain, and by confenfus, the reil: of fymptoms thought to attend difficult dentition, are by no means endued with fuch a degree of fenfibility, capable of producing thofe affections j but that the gums, which, at the fuppofed want of a perioftium, are the only parts to be irritated, are nearly deprived of all fenfation, being a fpongy, fenfelefs fubftance. This afiertion ought, therefore, to be firft confidered ; and it deferves the firft place among the arguments that have been brought forward againlt the above opinion.
1. That the gums are really a very fenfible and irritable part.-No part of the body into which nerves do penetrate, can be faid to want fenfibility; and as the gums are undoubtedly provided with feveral nervous fibres, it ought to poiTefs the perception of painS Of the prefence of nerves in that part, no particular mention is made by the author of the above theory; on the contrary, he feems to treat the exprefiion of Sauvages, " a comprejjione nerrvi," with ridicule, and to pay to the nerves not that attention which they deferve. Every body, however, mav peri'uade himfelf of the exigence of nerves in the gums, by consulting the works of Hal-I,er, Soemmering, Monro, and particularly Meckel, (de quinto pare ner-itoriun cerebri, p. 63 and p6). The nerves that go through the bony cover by its root that, while increafing, is Tupported by the bafis of the alveolus preffing the head of the tpoth againft the cover of the alveolus, till yielding, it allows the tooth to pafs by degrebs. This is what they call the fhooting of the teeth.
The ftronger and harder the cover is, and the more refiftance it Ihows, the more the tooth prefles the bottom of the alveolus, by Which the nervous branches that go to the root are irritated, which particularly happens in the eye-teeth* From a preffure of thefe nerves, which have a very extenfive fympathy, fuch vehement fymptoms may arife as are recorded in the works of Bartholin, TiiTot, &c?
The tooth after having perforated the bony cover muft pierce thro* a proper vafcular membrane or perioilium, as we fee from the works of Soemmering, who fays, " that the head of the tooth having penetrated the perioftium appears bare, as the membrane only inclofes thofe parts of the tooth that are covered by the gums, and lie in the alveolus (On the Jlrutture of the human body, l7*. I. p. 207> in German). L. Heister calls this membrane, " Membranam vafculofo nerveam.'* The gums, through which the tooth is then to pafs, are in all points connected to the perioftium of the jaws, Which naturally increafes the fympathy.

570
Dr. Wichmann's Thtory of difficult Dentition* adults feel the moft painful fenfation at the appearance of the laf$ tooth, dens fapientiae, and cannot fufFer.then the flighteft touch on the upper part of the gums; hence it is probable, that in fuch a tender age, when dentition takes place, fimilar pains may be produced. The rednefs of the gums moft frequently attends a difficult dentition, and though it does not always occur, it feems to prove, that the gums become inflamed by the irritation of the teeth cutting through, of which it is an additional fymptom. 5. Dentition proceeds in two periods; in the firft of which, that is properly called the {hooting of the teeth, the tooth irritates the membrane in which it is inclofed, the fides of the alveoli and the parts adjacent. No fymptom of inflammation or fwelling of the gums is perceived.-In the fecond period the tooth breaks through^ Sometimes on a fudden, and without any pain. In fome inftances, an interval takes place between thefe two periods, but frequently the formation of the tooth proceeds uninterrupted, till it appears in its natural fize. According to this, two fpecies of difficult dentition may be likewife admitted, the true and the fpurious, the firft of which originates in the perforation of the alveolus and in the irritation and prefture of the neighbouring parts, the perioftium,, and the dental nerve, whence different nervous affettions may arife without any fwelling or rednefs being perceptible ; in the fecond fpecies, which is more common, the gums are extended, fwollen, and inflamed; and all the fymptomi increafe and become particularly urgent, when at the fecond period of dentition, the preffureof the nerve continues, or when the parts are irritated in this double way.
Hence it may be explained, why the, fymptoms of dentitio difficilis were obferved, without much fwelling or inflammation of th'e gums, and w hy they often ceafed when a fwelling and rednefs of the gums tfrere perceived, becaufe at the advancing growth of the tooth, the nerve and perioftium were no more irritated, and the irritation of the gums alone not fufficient to produce the fymptoms thai were perceived before this period. 6. With refpett to falivation, a fymptom that is often remarked at the period of teething, Dr. Wichmann is more inclined to afcribe it to aphthae, and to a mere irritation of the falival glands, than to attribute it to dentition. We may however obfeive, that aphtha are not always concomitant with this faiivation, which, as it keeps pace with the a ft of teething, may be more juftly thought to depend on the irritation of the teeth breaking through, that ads per confenfum on the falival fyftem. This caufe is at the fame time fo near at haad, that there is no reafon to fearch for another we know not.
Such are the arguments that may ferve to prove the exigence of an irritation in,the mouth at the period of dentition, fufficient to produce topical fyftems of difficult teething. It remains now to be examined, whether the general fymptoms that have been derived from difficult dentition are really owing to idiopathic affections, as is affcrted by Dr. Wichmann. However, before we rccur to that, quefticn, we. beg leave to obferve, that none of thefe general fymptoms fcems ought to be feparately regarded ; but that in order to be fully convinced whether any of them arife from the above caufe, it wiJl be the fureft way to enquire into the other fymptoms that attend dentition, and from the coexiftence and coincidence of other fymptoms, to conclude that they are caufed by the irritation of the the teeth. We readily agree with Dr. Wichmann, that fome fymptoms are owing to different caufes, not depending on dentition, or may at leaft have been produced by them, and we are not willing to deprhre 'this gentleman of the praife he merits, for having pointed out the truefource of feveral fymptoms, otherwife attributed to difficult dentition ; but we cannot forbear to confefs, that by utterly denying their origin from dentition, he has equally departed from truth. For, I. Mod of the general fymptoms attending difficult dentition are phenomena of an affection of the nervous fyftem, 2nd fymptoms of irritation and pain. How they are produced, appears from what we have above ftated. Convulfions are accordingly excited by the re-adtion of the topical affedtion on the whole fyltem of nerves, by which it buffers more or lefs, according to conftitutional difference. It is, farther, not at all inconfiftent with analogy and the laws of animal oeconomy, to derive fome other fymptoms which Dr. "Wichmann finds particularly abfurd to afcribe to dentition, from a confenfus of the topical irritation, viz. diarrhoea, ftrangury, &c. as we know, for inftance, that the affedtion of the olfadlory nerve by the fmell of a medicine, that adts as a cathartics produces the fame effect in fome perfons as if they had fwallowed it. A fever is likewife obferved to attend fome cafes of dentition, owing alfo its origin to irritation.
2. It is remarkable that a very intimate connexion and concurrence of the period of teething, and the formation of the teeth, and of thofe general fymptoms exift, which admit of no better explanation than to think them mutually depending on each other-Thev topical figns of dentition appear, and at the fame time the general fymptoms of it, keeping nearly pace with one another, as the laft moftly difcontinue as foon as the adt of teething is performed. The obfervations and experience of the mod refpedtable , praftitioners bear witnefs to this fadt, which feems to have been not (o much attended to as it deferves.
The incifion is utterly rejedted in this theory as an ufelefs~ operaiion, for which affertion he appeals to fome cafes where it was undertaken without fuccefs, and to thofe pradlitioners who profefied themfelves antagonifts to that operation^ The fuccefs ,of it, however, depends on the time and the period of dentition when it is reforted to.
According to our former ftatement of the two periods of dentition, it mull naturally prove without avail when the tooth has not yet pierced through the alveolus, and fervice can accordingly be expedted when the tooth begins to extend the gums; in which cafe it has been found extremely ufeful. To the authority of thofe phyficians who rejedl it, we can oppofe that of others who approved it, equalling thofe as well in number as in practical excellency.
i 57- Againft the general reflections which Dr. Wichmann Jtas fubjoined, may be obferved, that nature feems not to be, in any formation of parts, fo precipitate as in the aft of teething ; and by her proceeding in the growth of other bones more gently, thofe afteftions are avoided which we remark in dentition, even when the nature and fituation of thefe parts did admit of a fimilar irritation , of the fenfible and irritable fibre. It is by no means to be fuppofed, that dentition fhould be always attended with fymptoms . that render it difficult; but feveral circumftances mull concur, in order to produce the above morbid ftate; and as at the period of approaching puberty and fluxus menfium the conftitutiori may be afrefted by the change that is then experienced, this may likewife take place in that"operation of nature. How eafily the animal body is influenced by the aft of teething, appears from the obfervations of naturalifts, who have rerrjarked that the brute creation fuffer greatly by dentition; and it is related that many young animals, horfes, lions, &c. fall a facrifice to difficult dentition. When we do not perceive thofe fymptoms in adults, fuffering the fevereft tooth-ach, we fhould always recolleft; that dentition of children proceeds in a tender age, where the irritability of the body is very great, and the confenfus more extended than afterward. This may fuffice to ftiew, that dentition ought not to be ex?. ploded from the lift of morbific caufes, as Dr. Wichmann iiv tended by his obfervations.
Mr. Whalely^ on Strictures in the Urethra.
(Concluded from p. 497?4.82 of our laft.) Mr. W. commences his own method of treating Striflwes in tbs Urethra, by the Caujiic, with the following obfervations and cau% tions, viz. " Before entering on the particulars of my propofed method, it may not be improper to repeat, that it is eflentially neceflary, in our prefent imperfeft acquaintance with the cauftic, to endeavour to dilate all-ftriftures of the urethra by means of common bougies, before any attempt b; xnade with the cauftic to efFeft their cure. Mr. Home, indeed; informs us, that this has been done in almoft ev.ery inftance adduced in favour of the cauftic. As, however, even in the cafes related by him, there are fo many inftances of ferious eftefts produced by the cauftic, it is highly neceflary to enforce this rule; a rule which, I fear, is not very ftriftly obferved by fomc practitioners. ,' ?f According to our prefent experience, I would confine the praftice of applying this remedy altogether to fuch ftriftures of the urethra, 'as'are either utterly impervious, or fo contrafted, as to be incapable of dilation by the common bougie: for the urethra., even in its healthy ftate/ being tender and irritable, and connsfte^ Conne&ed with parts of great importance in the fyftem, all ylolent remedies fhould be very cautioufly applied to it.

"
One of the objections made to ^e ufe of cauftics, for re-? moving ftridiures of the urethra, is the impra&icabilify of confining their a&ion to the conftride'd part. But, I.muft confefs, I do not perceive the force of this obje&ion; for I think, that they may be almoft always applied to fuch part with great oicety. Wifeman, and other ancient furgeons, applied efcharotics of different kinds, by means of adhefive plainer at the end of bougies, in order to remove obftruftions and excrefcences, which they fuppofed to exift; in the urethra; the former likewife ufed a canula foi1 the purpofe of introducing a cauftic. This practice, however, in confequence of the danger fcund to arife from it, was laid afide for near a hundred years; but was revived by Mr. Hunter, who, as remarked at the beginning of the former effay, introduced the lunar cauftic to ftri&ures of a certain defcription , at firft through a canula, and afterwards by.enclofmg it in the end of a common bougie. Very lately, Dr. Sherwin has ingenioufly propofed to remedy the inconveniences of the cauftic bougie, by applying a certain quantity of the lunar cauftic in powder, at the end of a warm whalebone bougie^ to which it is to be fixed by adhefive plaifter, or any other vifcous fubftance. This method, however, does not appear fufficiently tp fecure the fides of the urethra from being injured by the cauftic in its paffage to the ftri&ure ; belides, there is danger of the plaifter being detached from the whalebone, before it has reached the tfrittured part.
" About two months before I heard of Dr. Sherwin's propofal, J made feveral elfays to difcover a fubftance that would make the cauftic adhere firmly to the bougie, and yet not hinder its diffolving on the conftri&ed part. The following method will completely anfwer both thefe purpofes: Touch an eighth, or from that to a quarter of an inch, of the end of a bougie of any fize, with a fmall brulh dipped in common glue, as ufed by mechanics; and let the coating of glue be as thin as pcjjible. The glued end mull be immediately applied to a given quantity of powdered, lunar cauftic, put upon a piece of writing paper; this fhould be done, by alternately putting its different fides to the cauftic, until the whole of it adheres. The bougie in this ftate mull be laid in fome dry place to harden, which effedt will take place in a few hours. When it is fufficiently hardened, the glued end muft be gently rolled to and fro upon a table, with a bit of fmooth Woodi about four inches fquare, till it is perfectly level and fmooth, If the bougie be very hard, or the weather cold, this end fhould be previoufly warmed a little by a fire. The part thus covered with cauftic fhould then be very lightly rubbed with a bit of bees wax, witli the intention of giving it a very thin coating of this fubftance. After this, let it be kept for ufe in a glafs <vejjel well clofed. The glue fhould be made of fuch a degree of confiftence only, as will make the cauftic adhere to the bougie,and become hard when expofed for a moderate time to a dry air. If it be made tQ9 ftiff, it will be attended attended with the inconvenience of requiring a longer time in being diflolved, when applied to the conftriCted part; on this account too, the coating of wax ought to be as thin a3 poffible.
" The advantages attending the cauflic bougie prepared in this manner are obvious.
''In the firft place, the bougie maybe of any fize; even the fmallefl fize can, by this method, become the vehicle of this powerful remedy; and may be readily paffed into, or a little beyond, fuch itriCtures as are extremely narrow; or fuch as are attended with a confiderable contraction of the orifice of the urethra. " Secondly. From the protection afforded by the wax coating, no part whatever of the cauflic touches the fides of the urethra in its pafTage to the ftrifture. " Thirdly. A determinate quantity of the cauflic may be applied with certainty.
" Fourthly The cauflic cannot be feparated from the bougie.
" Fifthly. The cauflic may be made to aft on the whole furface of the ftriCture at each application. " Sixthly. Where there are more ftriCtures than one, and it is thought advisable, to attend to one only at the firft; the cauflic may be direCted, and confined in its aCtion, to any particular ftricture, upon which the practitioner may wifh it to operate, in preference to the reft. <l Seventhly. Fixing the cauflic with glue has this additional recommendation; we can attach it with perfeCt fafety to the extremity of a bougie, and thereby apply it with more certainty to an impervious ftriCture, than is practicable with the common armed bougie.
" When we have determined to ufe the cauflic bougie thus prepared, the diflance of the conftriCted part from the extremity of the penis fhould be accurately meafured, in order to apply it with certainty to this part only. This may be done with a common bougie.- The exaCt fize of the canal at the part fhould likewife be afcertained by the fame inflrument. This in general may be readily done. They who are ufed to pafs a bougie of a proper fize through a ftriClure, can always tell when the point of this inflrument is about to enter it. When it firft touches the ftriCture, it generally flops; but on preffing the bougie gently on, it evidently feels as if its point entered a pafTage, which embraces it on every fide. The bougie paffes on afterwards more or lefs freely, according to the fize of its upper part, and the opennefs of the pafTage beyond the ftri&ure. N " Having afccrtained thefe points, it will be proper to choose a bougie armed with cauflic, in the manner already mentioned, of a fize rather lefs than the conftriCted part. A piece of fine white thread fhould then be tied round the bougie, at the exaCt diflance of the llriCture from the end of the penis, and another thread a quarter of an inch nearer the external end. By the firft of thefe marks it will be known with great accuracy, when" the bougie enters the conftriCted part; and the fecond will determine how far it is pufhed beyoidt Mr. JVhately cn Strictures In the "Urethra, 57$ beyond it. This armed bougie (previoufly oiled) may now be pafied down to the ftri&ure, and about the eighth of an inch into it, and continued in this fituation from five to ten minutes, now and then alternately moving it forward and backward, about the eighth of an inch each way, in order to wipe off any mucus which may have colle&ed upon the cauftic, and to affift in wiping off the cauftic itfelf. On withdrawing the bougie, all the cauftic will be found to be diffolved; whence we may fairly conclude, that it has been expended entirely on the conftridted part. " If the ftridure be open enough to admit a bougie of a moderate jTize, fuch a bougie, armed with cauftic, may very readily be paffed into it, or a little beyond it; but, if the ftri&ure admit only a very fine bougie, and cannot be dilated fo as to receive one of a larger fize, great care fhould be ufed in paffmg a cauftic bougie of a fmall &ze into the ftridture. For if this fhould not be effected, and its extremity be bent in endeavouring to pufh it forward, much effedfc cannot be expetted from the cauftic, as it will be diffolved at a part of the canal anterior to the ftricture. From what has been faid, it is evident, that the fuccefs of applying the cauftic by this method will depend very much upon the nice manner in which it is performed.
*' With refpeft to the quantity of cauftic which ought to be applied to a firi&ure, I am convinced, that, on the firft trial, it fhould in no cafe exceed one-twelfth part of a grain." As Mr. Cartwright has propofed a new method of applying the cauftic in thefe cafes, and difapproves of that recommended above, (See page 513) we fhall take this occafion to fuggeft a few oblervations on his plan.
The method which Mr. C. adopts of applying lunar cauftic in "powder to aftriftuie of the urethra, by means of the broader end of a common bougie introduced through a flexible gum canula, appears to us to be more uncertain in its effe& than that which Mr. Hunter recommends of applying a bit of the fame cauftic in a port crayon through a flexible lilver canula, or by means of his armed bougie now in ufe.
In the firft place, as no means are employed to make the cauftic adhere to the end of the bougie, the quantity of it actually applied to the ftridture muft be uncertain.
Secondly, The flat end of a bougie cannot be applied with certainty even to the anterior part of a ftridture when it is much contradled, whereas the conical point of the cauftic in the port, crayon is well adapted to this purpofe.
Thirdly, As it is not propofed by this method, that the cauftic bougie fhould be paffed into, or a little beyond the ftri?ture, even in thofe cafes which will admit a bougie of a middle fize, much of the benefit to be expe&ed from the ufe of the cauftic will be loft in applying it to the anterior part of the ftri&ure only, as the liquefied' cauftic will flow anteriorly; for all fluids in the urethra flow towards t te extremity of the penis by means of the mufcular a&ion of it$ canal.
Fourthly, Fourthly, The fiat end of a bougie thus armed with cauftici cannot, from its fize, be parted into or through a very narrow "ftricture ; and as the cauftic is of more ufe in ftri&ures of this kinti than in any others, it muft be confined in its application to the anterior part of them only, which, as already obferved, is an uncertain mode of applying it.
The objections which Mr. C. has made In his Poftfcript to Mr. W's mode of applying the cauftic in thefe cafes, do not appear to us well found&d.
When the whole of the cauftic fixed upon the end of a bougie by means of glue, is perfectly dilTolved and liquified upon a ftridtured part of the urethra, it muft of courfe immediately aft upon that part, and if the bougie be fuffere'd to remain upon the ftridture until this effeft takes place, (which, according to Mr-Whatley) requires'to be done from 5 to 10 minutes) is it pofiible that the withdrawing a bougie thus perfdtly freed from its cauftic, along the found part of the urethra, caii be an infuperable objection to its ufe, and attended with mischievous confluences ?
That the very extremity of a bougie, armed with cauftic by means of glue, muft be immerfed in the moifture of th? urethra# which difl'olves the cauftic, is certainly true ; but it is evident, that the very fmall .portion of liquid which adheres to it, muft be wiped off the moment the bougie is attempted to be withdrawn; Belides, were this an infuperable objection to this mode of applying the cauftic, it would be equally an infuperable objection to the mode of applying it by the flat end of a bougie, as recommended by Mr. C. As fuch an end would retain a portion of the liquified cauftic upon its iurface, more of it would alfo unavoidably adhere to the extremity of the canula; and when both were withdrawn, mifchie-uotis confequeuces muft neceflarily arife to the found part of the urethra, if fuch confequences enfue upon withdrawing the bougie after Mr. W's method of applying the cauftic. This powerful remedy may, indeed, be in a very trifling degree weakened by its admixture with the glue; but this appears to us to be even an advantage in fome cafes, as lefj mifchief or pain may thereby enfue from its ufe in very irritable habits; and the aftivity of this application is fuch, (if it be kept in a glafs veffel well clofed, as directed by Mr. Whately) that the very fmall quantity of thin glue with which it is mixed, cannot, one would fuppofe, prevent its a&ing with power on any furface to which it is applied, which appears to be proved by the cafes Mr. Whately has given; and whenever a greater effeft is neceffary, it would appear to be a very eafy matter to make a little addition to the quantity, after it has been proved that the lefs quantities have not had the required effeft.
As Mr. C's objedl is the improvement of his profeffion, he will not be difpleafed at thefe hints, which we hope he will improvev Dn \ C 577 3 Dr. Baeta's Comparative View, ( Concluded from p. 388?391. ) \ Cf When the torpor from exhauftion of fenforial power affetts other parts of the fyftem, which have their attions aflociated with thofe of the ftomach, as, for inftance, the fpleen, liver, &c. the ftomach falls into a torpor, from defett of excitement of the fenforial power of aflociation, and fo the arterial fyftem, till a general torpor is formed, which conftitutes the cold fit, (Sett. xvii). Now during the cold fit, an accumulation of fenforioal power of , aflociation takes place in the ftomach, arterial fyftem, &c. which overbalances this defeat of excitement of the fenforial power of zflbciation: confequently, thefe parts are thrown into increafed attions. This conftitutes the hot fit, which, according to the accumulation of the fenforial power of aflociation, and to the ftimuli applied to it, will produce various effects (Princip. 4. and note (n) Princip. 15). Thus either thefe increafed attions may be proper, to reduce the fenforial power of aflociation, accumulated during the cold fit, to its juft limits, and at the fame time to afrett, by means of aflociate motions, (Princip. 5. and 8.) that part which is torpid from exhauftion of fenforial power, jo as to reftore its juft degree of deriving fenforial power from the brain and fpinal marrow; and then the fever is cured: or thefe incrcafed attions merely reduce the fenforial power of aflociation to its natural ftandard, while the fpleen, liver, &c. remain yet in a torpid ftate, which, either by its degree, or by the concurrence of other caufes, may induce again the torpor of the ftomach, &c. in confequer.ce of defett of excitement of the fenforial power of aflociation. Hence various kinds of intermittent fevers, or thefe increafed actions, may be in fuch a degree, as to occaflon fenfation. Hence inflammatory fevers (Princip. 15). Or laftly, thefe increafed attions may, in confequence of their violence, producc a fmaller, or greater, or complete exhauftion of fenforial power, in fome part efi'ential to life. Hence various kinds ?or continued fever with arterial debility (Sett. xx, xxi, and xxii,) or even death (Princip. 15).

57S
2V. Baefa's Comparative View, increafed heat (Sett. xx.) : 7thly, for the abfence of the increafedattions of the capillaries, in fome fevers with arterial debility, as evinced by the abfence of increafed heat over the body (Sett, xxi.): Laftly,' for the long duration of continued fever with arterial debility (Sett, xxviii.). See the foregoing cafes. " From the fame dottrine of fever the moll proper indications of cure are deduced.?ill, According to it, we mull excite the fyftem in the cold fit of fevers, taking care, however, to proportion theNftimuli to the fenforial power already accumulated.
By thefe means we prevent the accumulation of fenforial power, which may give rife either to the hot fit (Sett. xvii.), or to inflammation, &c. (Sett, xxiii.) Hence Dr. Darwin's expreflion (Zoonomia, vol. i. Sett. 12.) " The true means of curing fever " (with ftrong pulfe) muft be fuch as decreale the attion of the fyftem in the hot fit, and increafe it in the cold fit." " 2dly: According to the fame dottrine, during the hot fit of fevers with arterial ftrength, we are led to diminifh the increafed attion of the fyftem; fince by this means we prevent the inflammation, which may arife during the hot fit in sonfequence of thefe increafed attions, and various other diforders (Sett, xxiii.). Hence Dr. Darwin fays (Zoonomia,vol. ii. Supl. I,16,9.). " The cure ^ of fever with ftrong pulfe (in the hot fit) confifts in the rew peated ufe of venefettion, gentle cathartics, diluents, Sic." " 3dly. According to the fame theory, it appears, that the cure of fevers with arterial debility and increafed attions of the capillaries (Sett, xx.) confifts in reftoring the energy of the ftomach and arterial fyftem, and in decreafing the morbid increafed attion? of the capillaries. The firft of thefe is obtained, by exciting into attion the torpid ftomach (and confequently the arterial fyftem) either direttly as by wine, opium, bark, &c. and food in fmall repeated quantities; by flight elettric fhocks pafled through it ; by fomentations with water, heated to 96 or a 100 degrees of Fahrenheit's thermometer; by exciting its power of aflociation with other parts' of the fyftem, as by a blifter, or indirettly, as by the exhibition of emetics, or iced water, &c. Hence the remarkably good effetts of wine, bark, emetics, &c. in the foregoing cafes of fever, chiefly in that of R. Feemifton, under Dr. Hope's care. The fecond of thefe indications is obtained by free admiflion of cold air, and chiefly by the ablution with, or affufion of cold water over the furface. Hence the manifeft utility of the affufion with cold water, ordered by Dr. Gregory in the foregoing cafes, and likewife of the affufion of cold water, fo much recommended by Dr. Currie-When thefe two means, viz. the invigorating the attions of the ftomach, &c. bv fmall repeated dofes of ftimuli, and the weakening the energetic attions of the capillaries of the Cicin, by ablution with or affufion of cold water,, are ufed conjointly, they are found to be of the greateft utility in the cure of fevers of this kind. " Lafily, from Dr. Darwin's dottrine, it appears, that in fevers, "with arterial debility and decreafed attions of the capillaries (Sett. xxi.} XXi.) the cure confifts in reftoring the energy of the fyftem, but particularly of the fecerning veffels of the brain. Hence all thofe Jubilances which may have the power of exciting thefe veflels, will foe ufeful in this kind of feyers. Opium and wine are fuppofed by Dr. Darwin to polfefs this pOwer (Zoonomia,vol. ii. Supl. 1,16,9). judge of the various difeafed appearances he will frequently meet with on opening dead bodies. After a nice description of the mode of differing the abdominal mufcles, the lima alba, the line a Semilunaris, &c. the Author gives the following judicious directions Dn Hernia, Dropfy, and Afcites, difeafes as connected with the anatomy of thefe mufcles. " It is wrong to cut acrofs the belly in opening colle&ions of matter amongft thefe mufcles, unlefs they have been deftroyed by the matter; becaufe the fibres of the mufcles are then cut acrofs, hence they retradl, and form a gap; and at the fame time the pof-Ability is increafed of wounding the epigaftric artery which runs up the belly. By opening thefe abfcefles with an incifion parallel to ?the fibres of the mufcles, the parts are divided, without allowing the mufcles to retradt; and the chance of wounding the arteries is lefTeped. In tapping for the dropfy, it is faid that the epigaftric artery (the courfe of which I have marked in the plate with a dotted line), is fometimes wounded, or its accompanying vein. But it fhould be expe&ed, when thefe were wounded, that while the canula remained in the wound, diftending the orifice, they fliould not bleed. If they fhould bleed, however, they may probably be flopped by preffing the canula obliquely to one fide. I have never feen an accident of this kind; but fuch cafes have been defcribed to me, where the deluge of waters was coagulated in the tub. Perhaps an enlarged fpleen, or fome of the vifcera touched with the trochar, may fometimes account for fuch a bleeding." The Author's dire&ions for the mode of opening the abdomen, to inveftigate the feat of difeafe, are clear and fimple. Thefe are the ftages: " Make a crucial incifion, at once laying open the vifcera ? or, if in a female, make your incifion fo as to leave a triangular flap to fall over the parts of generation, by continuing your longitudinal cut no further than the umbilicus, and from that point, making an oblique incifion on each fide, towards the projecting point of the ilium, forming thus three triangular flaps.
Then obferve whether the parts are in their natural fituation: examine the omentum, the ftomach, the fpleen, the inteftines, and then the liver and gall dudls. Then feparating the ftomach and colon, connected by the omentum, raife the .ftomach, and examine the pancreas?Cutting up the adipofe membrane, examine the kidneys, by making a feftion of them. Then following the ureters, examine the contents of the pelvis, &c. In making up your cafe, firft mark the general deviations from the healthy appearance of the vifcera; then detail the hiftory of the difeafe, and take notice of any anomalous appearances which feem unconnected with the principal difeafe. " On this fubjeft (Difeafe of the Abdominal Vifcera) it is of importance to ftudy the nature of inflammation, of adhefions, and fuppuration, and the almoft uniform confequence of difeafe upon the peritoneum. It will be eafy, when this knowledge is acquired, to up.ravel the difeafed vifcera^ which, without it, muft appear cocfufed and intricate, " ACUvs (t Adlive inflammation fhould be diftinguifhed from turgidity of the veflels; for often a fullnefs of the vein?, mechanically produced, is defcribed as an a&ive inflammation in the brain and in the pleura, and ftill oftener in the abdomen. In dropfy, in violent diftenflon of the inteftines, in tympanites inteftinalis, and after child-bearing, the veins of the inteftines and peritoneum are often found diftended with blood. But in real inflammation, the peritoneum becomes thickened, pulpy, and lefs tranfparent ? the blood isalfo of a brighter red colour; a circumftance which feems not to be owing to a peculiar property in the inflamed part, of preferving the arterial colour of the blood (as Mr. Hunter fuggefts), but to its more general fuflufion. " As the eye becomes dry and painful and inflamed when the eye-lids are forcibly kept open and prevented from fpreading the fecretion upon its furface; fo, when the enveloping membrane of the vifcera is expofed, the natural fecretion of its furface is deilroyed, and it is irritated and inflamed. Or, by inflammation from any other caufe, the fecretion is deftroyed; the parts lying in contadl are no longer kept feparate ; they mutually afted each other; and producing a new adlion, unite.
" Adhefions are produced in the peritoneum and inteftines in a ?wonderfully flrort time ; and the fmooth membrane, when it is torn from its new connections, appears cellular; or, upon being cut, thickened, and folid ? or if the furface have undergone fevere inflammation (without being allowed to form thefe adhefions which are fo frequently the confequence of inflamed peritoneum), its furface becomes ragged, and numerous floculi of new membranes are formed upon it. " In difeafes where inflammation has fpread among the vifcera, it is generally underftood that the peritoneum is the original feat of the inflammation.?And according to this view of the fubjefr, It appears upon difledtion, that the inteftines do more readily than the mufcles participate in the inflammation of the peritoneum. The mufcles are indeed guarded in fome meafure by the loofe cellular iubftance, which feparates them from the peritoneum. But this does not fatisfa&orily account for what in the above view appears to be fo great a difference between die fympathy of the inteftines and that of the mufcles with the peritoneum. The true explanation feems to be, that the difeafe or inflammation is in general communicated, not from the peritoneum to the inteftines, but from the inteftines to the peritoneum.?It is the difeafe of the inteftines which produces thofe deadly fymptoms that are faid to mark inflammation of the abdominal cavity; and although there are difeafes in which the peritoneum is peculiarly the leat of inflammation; yet the inflammation of the peritoneum, produced by any external caufe, is dangerous only by propagating its inflammation to the inteftines." The Author's obfervations on the ftomach, duodenum, and //wr, are fo important, that we fhall give them atdength in our next This truly philofophical and philantrophic work will doubtlefs be read by every friend of humanity, and the medical profeffion. Short extratts would convey no adequate idea of its merits; and long ones are inconfiftent with our plan; we mull: therefore refer our readers to the book itfelf.
Infrutiions relative to Self-prefer vation during the Prevalence of contagious Difeafes. By a Phyfician. 8vo. pp.14, price 6d. London, 1801. Seely, Callow, &c. lie the Advertifement prefixed to this fhort Pamphlet, the Author ebferves, that " Contagious and malignant Fevers have of late prevailed,. and ftill continue to prevail, to an unufual extent, in the metropolis and other parts of the kingdom. The contagion is, unknowingly, carried from place to place by numbers j who, if they were made acquainted with the neceffary precautions and directions, would ceafe to be the propagators of infeftion, and would be enabled to nip the evil, whether in themfelves or others, in the bud. , This is a fubjett which concerns perfons of every defcription, but more efpecially the heads of families and proprietors of fchools. It has attra&ed the notice, and repeatedly employed the pen, of Dr. Haygarth, and other able and philanthropic phyficians; but none of thefe gentlemen appear to us to have treated this fubjeft upon a plan adapted to the ufe of the better clafs of houfekeepers^ ?a plan which we have attempted in the following pages. " P. S. While this pamphlet has been printing, a new performance has appeared, from the pen of Dr. Haygarth, entitled ' A Letter to Dr. Per rival, on the Prevention of Infectious Fevers, read to the Literary and Philofophical Society of Bath but as this Treatife, which exhibits fo fine a fpecimen of patient refearch and juft reafoning, will, it is probable, be read only by thofe who belong to the medical profeffion ; it will not fuperfede the neceffity of a fet of infcru&ions defigned, like the prefent, for the ufe of the community at large." In this plain and ufeful work the following fubjetts are confidered, viz.